MEDICARE: ASHLEY ELITA BAILEY PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	40765	TN

General Provider Information

NPI Number	:	1063377182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELITA BAILEY PMHNP-BC

Provider Business Mailing Address
First Line	:	2502 MOUNT MORIAH RD STE H231
Second Line	:	PMB 1098
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	901-215-8494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 MOUNT MORIAH RD STE H231
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-1515
Country	:	US
Telephone Number	:	901-215-8494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2025
Last Update Date	:	03/18/2026

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